Provider Demographics
NPI:1689896847
Name:DOUGLAS O. FLEMING, O.D., INC.
Entity Type:Organization
Organization Name:DOUGLAS O. FLEMING, O.D., INC.
Other - Org Name:SIERRA VISTA OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:209-532-4123
Mailing Address - Street 1:940 SYLVA LN STE H
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5969
Mailing Address - Country:US
Mailing Address - Phone:209-532-4123
Mailing Address - Fax:
Practice Address - Street 1:940 SYLVA LN STE H
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5969
Practice Address - Country:US
Practice Address - Phone:209-532-4123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9525T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD000290Medicaid
CAGSD000290Medicaid
CAZZZ30972ZMedicare ID - Type Unspecified